156167 02/06/2008 CITY OF CARMEL, INDIANA VENDOR: 357010 Page 1 of 1
ONE CIVIC SQUARE FIRST AVENUE COOKIE COMPANY
6a 2
CARMEL, INDIANA 46032 791STAVE SW CHECK AMOUNT: $89.10
CARMEL IN 46032
CHECK NUMBER: 156167
CHECK DATE: 2/6/2008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUM AMOUNT DESCRIPTION
1160 R4359003 16224 120107 89.10 COOKIES -ARTS DIST
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FIRST AVENUE COOKIE CO,
Invoice
Invoice #:12/01/07-1
Invoice Date: 12/01/07
Customer ID: Andrea.
Biu, To: Si ii P TO:
CRC Office —SAME—
Date Your Order Our Order Sales Rep. FOB Tax ID
Shij,Via Terms
12/1/07 Jessica
Quantity Item Units Description Discount Taxable Unit Price Total
18 Doz. 1/2 size Gourmet Cookies 5.50 a Doz. 99.00
Discount 10% 9.90
Subtotal 89.10
Tax .00
Shipping
M'scellanecus
Balance Due $g 10
REMMANCE
Customer ID:
Date:
Amount Due:
Amount Enclosed:
First Ave. Cookie Co. Phone: 317- 848 -2253
79 1 st Avenue S.W. Fax: 3 17-566-9901
Carmel, IN 46032 Email: dimferrinftrocligy.net
INDIANA RETAIL TAX EXEMPT PAGE
Cify o f� II Carmel CERTIFICATE NO. 003120155 002 0 JL Jlli PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT
35- 60000972 i
ONE CIVIC SQUARE THIS NUMBER MUST APPEAR ON IN A/P
CARMEL INDIANA 46032 -2584 VOUCHER, DELIVERY MEMO, PACKING SLIPS,
SHIPPING LABELS AND ANY CORRESPONDENCE.
FORM APPROVED BY.STATE BOARD OF ACCOUNTS FOR CITY,OF CARMEL 1997
PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
SHIP
VENDOR t U.
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CONFIRMATION BLANKET CONTRACT PAYMENTTERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
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Send Invoice To:�
PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
PAYMENT
A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.
NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
SHIPPING INSTRUCTIONS I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
SHIP REPAID. THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER.
C.O.D. SHIPMENTS CANNOT BE ACCEPTED.
PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY
SHIPPING LABELS.
THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945 TITLE
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
CLERK- TREASURER
DOCUMENT CONTROL NO 16 2 24.V. COPY SIGN AND RETURN TO CLERK'S OFFICE
VOUCHER NO.— WARRANT NO...___
ALLOWED 20
IN THE SUM OF
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO# or INVOICE NO. ACCT /TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except,
20
Signature
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1995)
CITY OF CARMEL
An invoice or bill to be properly itemized must show: kind of service, where performed, dates service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
l SST
Aea L/ 4 (C>. Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
Total g9
I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accordance
with IC 5- 11- 10 -1.6.
20
Clerk- Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
IN SUM OF
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ON ACCOUNT OF APPROPRIATION FOR
060/ y35 oo3
Board Members
D EPT INVOICE NO. ACCT #/TITLE AMOUNT I hereby certify that the attached invoice(s), or
Z q 3J 0 bill(s) is (are) true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
200
S mn
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund